Latest New York Times look at Obamacare in Kentucky examines highs and lows of enrollees and people helping them

 Navigator Kelli Cauley helps an applicant. (Luke Sharrett, NYT)

While many states have suffered through complications in signing up uninsured people for health insurance under the Affordable Care Act, Kentucky has been leading the way in efficiency, enrolling about 1,000 people per day. Abby Goodnough of The New York Times was already using Kentucky as a lens to view the rollout of health reform, and in her latest story looks at major players in the enrollment process -- including the navigators for the state's Kynect website, insurance agents, and the uninsured -- exploring the ups and downs of each group.

"Though people can sign up on their own, navigators can help those confused by the sea of insurance options," Goodnough writes. "The navigators listen to people voice their hopes and fears about the law, and their hard stories about being uninsured. Often hugs are exchanged. Sometimes tears flow." One such navigator, or Kynector, is Kelli Cauley. The Louisville resident has put 1,000 miles on her car in the last month, and the stress of the high pressure job has caused her to lose 12 pounds. As part of her job, Cauley is one of eight Kynectors who have "to enroll 699 people per month in Medicaid or private plans through the exchange. They are required to hold educational events around the region, and the agency’s phones have been ringing nonstop with requests for enrollment help at health fairs, cultural festivals and other events that the uninsured might attend."

Cauley, a former home-economics teacher, said she "expects the job to get harder as she comes under pressure to help people who might be more reluctant to sign up than the early enrollees," Goodnough writes. "But she has some strategies: visiting small day-care centers, for example, where workers are likely to be uninsured. For now, just meeting the initial flood of requests is a strain." Cauley told Goodnough, "You do have to be on your A game constantly." The reward, though, is that she has been able to help dozens of people get coverage.

Insurance agents aren't getting the same warm feeling. Some agents "refuse to sell plans through the exchanges, which they see as a threat, and have instead focused on selling other insurance, like property and casualty," Goodnough writes. Some agents who are selling the plans, aren't seeing a silver lining in the results. Donald Mucci, who has been "an insurance agent for more than three decades, has yet to get comfortable with the new system and does not much like it. (He) resents that the health care law prompted insurance companies to cut commissions paid to agents. And he thinks the exchange website makes it hard for people to understand the pros and cons of various plans, such as which hospitals and doctors they cover. Yet Mucci, an affable man in monogrammed shirt cuffs, said he wants the system to work."

Mucci, whose firm, the Garrett-Stotz Co., has been in Louisville 82 years, has only enrolled a few customers in exchange programs. During a recent enrollment, his commission was $18, far less than what he normally gets, Goodnough writes. "The law requires insurers to spend at least 80 percent of money from premiums on medical care instead of on administrative costs, which include commissions to agents and brokers. Consequently, some insurers cut commissions, infuriating many agents and brokers."

Despite the long hours put in by navigators, and the concerns of insurance agents, the plan appears to be helping people in dire need of insurance. And in some instances, people are getting what they need, without feeling like they're being handed charity. One such case revolves around a woman Cauley helped, who would identify herself only as Kay. The well-dressed substitute teacher "learned that she would be eligible for Medicaid under the new law, but she was unwilling to enroll because of what she saw as a stigma attached to the program," Goodnough writes. She told Goodnough, “I don’t want to be a freeloader.”

But the cheapest option for Kay "through the exchange would be a plan with a $356 monthly premium and a $6,300 deductible," Goodnough writes. With that amount being too high, Cauley was able to find her an alternative. "Kay could sign up for Medicaid, but only use it in catastrophic events. For checkups and other routine care, Kay could pay her own way, perhaps negotiating a discount with her doctors." She summed up her situation, and perhaps the point of what health reform hopes to accomplish, saying, “You’re giving me an alternative I can live with." (Read more)